If we don't stop overdosing on antibiotics, even a simple scrape could be fatal. Here's how we got into this medical mess — and how we can get out.

It started as a blemish, but Bethany Burke, then 15, freaked out the way teens do over a small pimple on the forehead. At the time, her father was on a business trip in the Northwest — Sean Burke is a chemist with GE in Austin — and Bethany and her mother, Melissa, were about to board a plane to join him for a family vacation on the Oregon coast. "I can't go — look at this zit!" Bethany cried, but Melissa reassured her that it was no big deal, and they took off.

More From Good Housekeeping

As it turned out, it was a huge deal. While they were still on the plane, the blemish grew bigger. Then, after they landed and were in the car heading to the shore, more bumps spread across her face, including one on her eyelid, and she began to feel really sick. Over the next two days, they visited two hospitals; Bethany was given powerful antibiotics and then, when she didn't improve, two infusions of even stronger drugs. Nothing worked against the infection, which doctors suspected was MRSA — methicillin-resistant Staphylococcus aureus, a bacterium known for its ability to fight off the medicine thrown at it.

The Burkes returned to Austin, and shortly afterward, Bethany started to recover — it seemed the last shot of the IV infusion and a combo of two powerful oral antibiotics had subdued the infection (which did turn out to be MRSA). But her ordeal continued for two more years. Even simple sinus infections became challenging illnesses as doctors had to try a long list of antibiotics to fight them. She also suffered mysterious rashes and fatigue. She was so sick and missed so much high school that she had to repeat her junior year. "We were trying to keep her alive," says Melissa, "not studying for her SATs."

Bethany, now 19, has become a passionate advocate for the MRSA Survivors Network. "I want people to know about this infection," she says. "It's a lifelong thing for me. A paper cut could be dangerous." But the scariest part, she says, is the uncertainty: "I'll never know where I got MRSA."

There will be more stories like Bethany's, say experts, as bacteria develop resistance to the drugs that are supposed to kill them. "We've been warning about resistance for 20 years," says Adam Hersh, M.D., assistant professor of pediatrics at the University of Utah. "What's different now is that we know more about the dangers, and the dangers are getting worse."

Last fall, the federal Centers for Disease Control and Prevention published a report documenting the scope of the problem. At least 2 million Americans per year develop serious infections that are resistant to one or more antibiotics, and at least 23,000 die each year as a direct result of those infections. "In the last 10 years, resistance has risen at an alarming rate," says Edward Septimus, M.D., a member of the Infectious Diseases Society's Antimicrobial Resistance Committee. "At the same time, the pharmaceutical industry hasn't put significant resources into new drugs." Dr. Septimus's dark worry: "We seem to be entering a post-antibiotic era where certain patients are developing highly resistant infections for which we have very few treatments."

Back to the Past?
Hailed as a miracle when they first became widely available in the 1940s, antibiotics affect just about every area of medicine. A return to a world without them would be disastrous. "Unclean wounds and routine ills like urinary tract infections could be fatal," says Carol McLay, Dr.P.H., an infection-prevention consultant based in Lexington, KY. People would die more often of complications from diseases that put them at higher risk of infection, such as diabetes. Procedures that depend heavily on antibiotics to control infections — heart surgery, joint replacement, dialysis and transplants — would pose much greater risks. "Ultimately, a lack of effective antibiotics could limit the surgeries we'd even be willing to do," says McLay.

The CDC report details how that's already happening. Doctors are now seeing more infections that are difficult (or even impossible) to treat from CRE (carbapenem-resistant Enterobacteriaceae), a family of bugs that are impervious to almost everything in our arsenal. "This is new, and it's already one of the CDC's top threats," McLay says. Almost half of hospital patients with bloodstream infections from CRE die; that's 600 per year now, but the threat is growing.

The Burke family is still shocked at how quickly Bethany got so sick — and how many different drugs it took to finally wipe out her infection. And they appreciate how close they came to losing her. "Doctors always say two things about Bethany: 'We cannot believe she's not permanently disfigured' and 'She's lucky to be alive,' " Melissa reports.

Dubious Doses
Each course of antibiotics you take can make resistance a more serious problem. "If the drugs and your immune system don't kill all the bacteria, the resistant survivors have a chance to multiply," McLay says. They can even pick up resistant genes from other bacteria, explains Stuart Levy, M.D., director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine. That means they communicate and "learn from" one another.

Much of the problem stems from broad-spectrum antibiotics — those, like Levaquin (levofloxacin), that attack many strains of bacteria. While they wipe out the bad guys, these "big guns" also kill the healthy bugs in the gut that would otherwise compete with infectious ones and help keep them under control. (In contrast, narrow-spectrum antibiotics — penicillin, for example — target fewer types of bacteria.)

The aftermath of carpet-bombing with broad-spectrum drugs can give rise to infections of Clostridium difficile (C. diff), a type of bacteria that spreads easily, especially in hospitals. C. diff is difficult to treat — and kills about 14,000 people a year. Even when it's not fatal, C. diff is very nasty. "It eats away at the lining of the bowel and produces absolutely horrific diarrhea," says McLay.

Yet when it comes to prescriptions for office patients, it seems many doctors haven't gotten the whole message. It's true that the chances you'll be given an antibiotic for an acute respiratory infection have gone down to about 49% from the almost 60% odds of 20 years ago. But when M.D.'s do prescribe antibiotics for respiratory conditions, they now order the big guns 74% of the time, a recent study found. And here's the kicker: These infections are usually viral, not bacterial, and antibiotics, whether narrow- or broad-spectrum, don't work against viruses.

It's not just doctors' fault. By the time patients seek help for respiratory infections, they're usually feeling pretty miserable and may pressure their physicians for an antibiotic. "Doctors are overbooked and don't want to argue, so they write what the patient wants rather than taking 15 more minutes to educate someone who probably won't listen," says McLay.

Also, it sometimes isn't clear whether an infection is viral or bacterial. "In that case, there's still a perception that an antibiotic won't hurt and might help," says Dr. Hersh. "But that's nottrue." Or if the doctor suspects you have a bacterial infection, but isn't sure which bug, a broad-spectrum drug can be an easy fallback.

Then there's the convenience factor. "Zithromax is attractive because you take it once a day for five days instead of the usual drawn-out dosing for other antibiotics, often three or four times a day for a week or 10 days," says Dr. Hersh. Patients like that ease and the compact packaging: "Some will just come into the office and say, 'Z-Pak really works for me.' "

Farm-Raised Superbugs
Hours after eating a ground turkey burger in June 2011, Diana Goodpasture of Barberton, OH, woke up in the night with severe diarrhea. "I thought I had the flu," she says. Instead, Goodpasture, 67, was affected by a salmonella outbreak that sickened 136 people in 34 states. She was so ill that her son insisted she go to the hospital: "I could barely lift my head off the pillow and, worse, I learned that my potassium levels were dangerously low, threatening my heart."

Intravenous treatment with Cipro (ciprofloxacin) probably saved Goodpasture's life. But while the strain was vulnerable to Cipro, it was resistant to ampicillin, tetracycline and gentamicin — all commonly used antibiotics. And in 2013, a similar salmonella outbreak spread by chicken featured several multi-drug-resistant strains that sickened 430 people, nearly 40% of whom needed to be hospitalized. Public health officials and others have been raising concern about routine antibiotic use in farm animals for many decades. The drugs are added to feed both to prevent infection (a risk in the overcrowded conditions of many livestock enterprises) and to promote growth so animals can be brought to market sooner. The result: development of antibiotic-resistant strains, which then spread into the human community. Now, finally, such concerns are being taken seriously. Last December, the FDA issued new guidelines, which hopefully will reduce risks from outbreaks like the one that threatened Diana Goodpasture.

Scary Side Effects
Beyond the risk of creating superbugs, there are other reasons to use antibiotics judiciously. In 2013, the FDA announced that Zithromax could cause abnormalities in the heart's electrical activity, potentially triggering dangerous — even fatal — irregular heart rhythms. The FDA also updated the warnings about fluoroquinolones, a class of antibiotics that includes Cipro and Levaquin, noting that they can cause nerve damage resulting in pain, burning, tingling or numbness in the arms and legs. Meanwhile, a recent study found that these drugs may increase the risk of blood sugar problems in diabetics. These issues are rare, but using an antibiotic for a viral illness when there's virtually no chance it will help makes these harms more significant, says Dr. Hersh.

What's more, researchers increasingly find that disrupting the normal balance of bacteria in the gut with antibiotics may have far-reaching consequences. Boosting the risk of a C. diff infection is one. There's also evidence that exposing young infants to antibiotics can increase their risk of obesity, allergies and inflammatory bowel problems like Crohn's disease.

None of this means you should refuse all antibiotics for yourself or your family. The drugs can still save lives and prevent complications such as hearing loss from an ear infection or kidney damage from a UTI. But everyone — from doctors to patients to parents — needs to remember that antibiotics are powerful drugs with effects few imagined in the 1940s. They should absolutely be taken when necessary — but only then.